Sunday, February 24, 2008

A new granddaughter entered my life last week, December Lynne Moore. I am so excited to have this new addition to our family; out of 17 grandchildren she is only the fourth girl.

My son and daughter-in-law already have 3 little boys age 5 and under; a new daughter will certainly change the dynamics of their family! Derrick, the oldest, is the little helper, and is doing what he can to help Mommy and his baby sister, and he asks frequently to hold her. Skyler at first didn't even want to see his sister. He's not sure about this new addition to the family that is taking Mommy's attention and he would rather ignore her. Collin, just two, has always had separation anxiety when either of his parents leave. As long as Mommy or Daddy stay with him, he seems ok having this toy baby around. But life has changed for all of them, and there is nothing any of them can do to change it back to the way it was before.

I've been without hot water for a week and a half. Something is wrong with the hot water heater. There were some problems so they couldn't get the part up until Friday. Then the part didn't work. They said they wouldn't be back until Monday. No matter how many calls I made, I couldn't get anyone to come up on Saturday. I'm still without hot water and I can't change it.

So many things happen in our lives, in our relationships, with our health, that no matter what we may do, we can't change. Things are out of our hands; we have no control over them. Going through "the change of life," or menopause, is one of them. We can't control the fact that our bodies are changing. But there are things we can do to make those changes easier to deal with.

As I said in the last blog, menopause is defined as that point in time when our periods stop permanently. Hormonal changes begin to occur before the actual menopause, and this period is called perimenopause, and may last from two to eight years.

Contrary to popular opinion, estrogen levels often remain relatively stable during perimenopause. They usually don't decrease until less than a year before the last menstrual period. During the menstrual years, the primary strong estrogen that the body produces is estradiol. During perimenopause, the primary strong estrogen changes to estrone, produced both in the ovaries and in the body fat. Estriol is another estrogen that is produced in fairly large amounts, but has a weaker affect on uterine and breast tissue. Estriol is the primary estrogen produced during pregnancy.

Testosterone levels usually do not fall during perimenopause unless there is excessive stress in a woman's life, at which time DHEA (precursor to testosterone) levels may fall, leading to less testosterone.

On the other hand, progesterone levels do begin to fall in perimenopause, often long before changes in estrogen or testosterone. This will often cause changes in the length, duration or heaviness of the periods, and is actually the most significant issue for many perimenopausal women.

All though reproduction is usually no longer an important goal during perimenopause, the "reproductive" hormones continue to play vital, health-enhancing roles in the body, evidenced by the fact that there are hormone receptors found in almost every organ of our bodies.

Among many other roles, estrogen, androgens (like testosterone and DHEA), and progesterone are important in maintaining strong and healthy bones and muscles and resilient vaginal and urethral tissue. Both estrogen and progesterone are important for maintaining a healthy collagen layer in the skin.

Progesterone is necessary for the body to make cortisol, the hormone that deals with physical and emotional stress, cortisone, the body's own anti-inflammatory, and aldosterone, which helps regulate fluid levels in the body.

Because the risk of heart attacks is much lower in women than in men until menopause, it has long been felt that these hormones played an important role in preventing heart disease.

Because of these reasons, for years women have been told that hormone replacement therapy (HRT) was the best thing for them as they reached the menopausal years, with the belief and sometimes evidence that there was positive effects on menopausal symptoms, cardiovascular disease, osteoporosis, vaginal and urinary symptoms, Alzheimer's disease, and possibly aging itself.

However, recent studies have discounted some of these effects. Most of these recent studies have used a combination of horse estrogens and synthetic progestins, (brand names Premarin, Provera, and Prempro). Premarin is made from estrogens from pregnant mare's urine. The principle horse estrogen in Premarin is called equilin, which is not found in humans. Equilin's effects on the lining of the uterus are up to 1,000 times stronger than the effects of human estrogen, and it also has much strnger effects on breast tissue.

Provera is a synthetic molecule that is similar to progesterone but not similar enough to call it progesterone. The molecule is called a progestin, meaning that it attaches to the progesterone receptors in the body and has a few progesterone-like effects. Studies have shown Provera to increase the risk of heart attacks, and it has several unpleasant side effects.

It has been shown that combination HRT with these "un-human" hormones seems to increase the risk of breast cancer, blood clots, stroke, and heart attacks. This has many women wondering how to deal with the symptoms of menopause and how to treat osteoporosis if they choose to not use or discontinue HRT.

It is important to remember that menopause is a natural process for the female body, and not a disease. Many women experience the cessation of their periods without any symptoms, receiving no treatment, and go on to live long, healthy and productive lives. Hormones continue to be produced (though in smaller amounts) in the ovaries, and may also be produced by the adreanl glands, body fat, liver, breast tissue, pineal gland and even hair follicles!

Whether or not a woman experiences symptoms during perimenopause and menopause depends on numerous factors, including but not limited to overall physical health, emotional and spiritual well-being, nutritional status, lifestyle and diet, how stress is dealt with, and genetics.

We will continue the discussion of hormone replacement therapy in the next blog, and talk about "bio-identical" hormones.

"Finding Joy"

Assignment Three: When difficult things or people seem impossible to change and life seems out of control, remember three things:

There are always an infinite number of possibilities.

Act, don't react.

I can always change my attitude.

I used to believe that when I came to a stuck place that I didn't seem to be able to change, I would only have one or two choices to make, and often neither of them would work. Then I learned from my friend, Hans, that in actuality there are always an infinite number of possibilities to work through problems. A simple example: I wake up to find my car won't start. I have a very important meeting at work. Living alone with no one else to drive me, the only choice appears to be that I will have to call someone to come fix the car and be late and miss the meeting. I'm stuck. I can't change the fact that my car doesn't work.

But if the meeting is that important to me, I can now put on my thinking cap and brainstorm. I think of every possible way I could get to work, whether they are practical or not. I could ride my bike, call a friend to take me, call a taxi, ask the repair place to take me, rent a car, call a co-worker to get me; or possibly I could call my work and rearrange the time of the meeting. or do the meeting over the phone on a conference call while the car is getting fixed, etc. etc. When I start to think of all the possibilities, suddenly the "unchangable" becomes possible.

When something seemingly bad happens that I can't change, I can either react to the situation with anger, frustration and fear, or act to resolve it or accept it. When I found out I wasn't going to have hot water for another four days, I reacted for a moment with anger. Then I decided to let the anger go and work on resolving it by finding another plumber. When I couldn't find a plumber to come on a Saturday, I started reacting with frustration. I decided to let it go and imagined myself as a pioneer heating my water for washing and bathing.

Then I began to see how very blessed I was, because unlike the pioneers, I didn't have to go out in the snow to the well for water. I didn't have to haul all the water into the house in buckets. I didn't have to chop the wood and build a fire to heat the water on. And I knew that this was going to end in four days. And my attitude about the situation changed, so I didn't have to hold onto the anger and frustration. Gratitude is the best attitude adjustment there is!!

Monday, February 18, 2008

We have two dogs at our house. Bruce, pictured here sharing his food with a friend, loves playing "fetch" more than anything in the world. He will bring a stick, a ball, a piece of plastic, anything he can find, and lay it at your feet and implore you with his eyes to pick it up and throw it. Once you do, he'll never leave you alone. Playing "fetch" 24 hours a day would be his idea of heaven.

"Fetch" requires several things of a dog. First, they have to chase after and find whatever is being thrown. Next, they have to bring it back to the thrower. Third, they have to let it go so the thrower can throw again.

Now Zeke also loves playing "fetch," but he lacks one of the skills necessary for a good game. He and Bruce will compete in this game, seeing who can get to the stick first. When Zeke gets it first, Bruce becomes very agitated, because he knows the game has ended. Because Zeke hasn't learned how to let go. He chases, fetches, brings it back, and then holds onto it. Letting go is too scary for him. He might lose it to Bruce if he lets go. But because he won't let go, the game and the fun ends.

Letting go is an integral part of life, even in nature. Clouds become so filled with water they have to let go of it. That water feeds the spring-time trees, allowing the leaves to bud and flowers to blossom. The flowers let go of their petals to turn into fruit, the trees let go of the fruit so they can bear more in the future. Then they let go of their leaves so that they can have a period of rest. Letting go is part of the cycle of life.

Our hands are so miraculous. There are a multitude of tasks, way too numerous to mention, that our hands can accomplish. But think what would happen if our hands could pick something up, but couldn't let it go. We would be stuck. When we refuse to let go of things in our lives, we become stuck. The game ends.

Menopause is a time time of letting go. We women get to let go of the cycles of our physical creative powers. This is a time when we also may need to let go of the image we have created about ourselves. Generally, around the time of menopause, our lives as well as our bodies are also changing. "The Change" is often not understated!

This may be the time frame when many of us are also letting go of one of the most important roles we have played, that of mother. Children are leaving the home; they don't need us in the same way anymore; they don't want our advice; their energies are on their studies, their jobs, their relationships, their own new families. We may find ourselves alone more. We may have to redefine ourselves as life shifts around us. We may begin to see, whether we have children or not, that the expectations we had out of life, out of our relationships, or even out of ourselves, are not coming to fruition. We may find ourselves letting go of these long-held expectations.

One of the changes most of us rejoice in is the letting go of the monthly bleeding. Menopause is defined as the time when there has been no menstrual periods for 12 consecutive months and no other biological or physiological cause can be identified. It is the end of fertility, the end of the childbearing years. Unlike men, who produce sperm "on the spot," so to say, women are born with a certain number of eggs in their ovaries. As the eggs begin to "run out," the hormone levels naturally begin to drop, causing the changes present in "perimenopause."

Perimenopause is a period of time before actual menopause, which begins about 6 years before the natural menopause. This is a time when the levels of hormones produced by the aging ovaries fluctuate, leading to irregular menstrual patterns (irregularity in the length of the period, the time between periods, and the level of flow) and hot flashes (a sudden warm feeling with blushing). Other changes associated with the perimenopause and menopause include night sweats, mood swings, vaginal dryness, fluctuations in sexual desire (libido), forgetfulness, trouble sleeping and fatigue. Except for the bleeding, many symptoms can carry over into the menopausal period for a time.

Natural menopause occurs when the ovaries naturally begin decreasing their production of the sex hormones estrogen and progesterone. Induced menopause occurs if the ovaries are surgically removed or damaged by radiation or drugs. Due to the abrupt cutoff of ovarian hormones, induced menopause may cause the sudden onset of hot flashes and other menopause-related symptoms. A "simple" hysterectomy (when the uterus but not the ovaries are removed) before natural menopause should not affect the production of sex hormones and so not cause menopause (unless the nerves or blood supply to the ovaries is damaged during the hysterectomy), though, of course, there will be cessation of bleeding.

In the western world the average age for menopause is now 51. Natural menopause can, however, be in a woman's 30s or 60s. Factors influencing the time of menopause include heredity (genetics) and cigarette smoking. Smokers (and former smokers) reach menopause an average of 2 years before women who have never smoked. High levels of physical and/or emotional stress can also cause menopause to start earlier. High levels of stress may also stop a woman's bleeding cycles even if she is not menopausal, so it is important to test any early cessation of bleeding.

There is no relation between the time of a woman's first period and her age at menopause. The age at menopause is not influenced by a woman's race, height, number of children or use of oral contraceptives.

Usually the symptoms and cessations of periods are adequate to "diagnose" menopause, but if there are questions, usually a blood test measuring the follicle stimulating hormone (FSH) and the luteinizing hormone (LH) is done. These levels become very high when the estrogen and progesterone levels drop.

On the next blog, we will discuss the pros and cons of hormone replacement therapy, both traditional and bio-identical.

"Finding Joy"

Assignment Two: identify the stuck places in your life and determine what is important to let go of in order to move forward. These may be in the areas of health, relationships, spirituality, jobs, home, etc.

Some of the things I've had to let go of:

the expectation of having someone always there to take care of me; I've found joy in being independent.

the expectations I've placed on some of my children; I am learning how to love at new levels, how to love and respect my children and all of my relationships exactly how they are.

the idea of being really thin again; after bearing six children, I appreciate and love my body the way it is and work to maintain it in the best health possible.

the belief that my children want my advice on how they raise their children; I've come to the realization that God gave their children to them and not to me for a purpose:-)

the belief that I have to sleep 8 hours night in order to function; before I let go of this belief I was tired all of the time. When I chose to let go of it, I found that I can function fine even if my menopausal body doesn't give me 8 hours of uninterrupted sleep.

the belief that I have to be spiritually fed by others; I found that my spirituality comes from within, and all life and every event can be an opportunity for spiritual growth.

the belief that I need other's approval and love to be good enough and to be happy; I now realize that my worth and my happiness depend solely on me.

Sunday, February 3, 2008

The snow keeps coming. Over a foot last night and it's still coming. This is my deck. It was completely cleared 3 weeks ago. I spend hours shoveling my driveway so I can get out of my garage and down the mountain, and overnight all my work seems in vain.

3 weeks ago we had a mini avalanche. Over two feet of snow suddenly fell off of the roof of our garage and fell on the arbor between the house and garage. The arbor wasn't strong enough, and crashed. The mess is so big we'll have to wait until the spring thaw to remove it. The snow continues to pile on top of it. This picture is Bruce, this morning, surveying the view from our porch. The garage is peeking over the pile of snow and logs.

I chose to live here. I've always loved the mountains; I've always loved the snow. I love my mountain cabin, and feel a great peace when I am here. Last winter it snowed a lot, and I thought, I can do this! Of course, the neighbors warned me that it was a mild winter. Now I see what they mean! This winter has brought more snow than has been seen in years, and there are many moments when I feel overwhelmed. I shoveled for hours this week, and it snowed more. My son came and helped shovel the driveway yesterday; today it needs it all over again. At times I wonder if I really knew what I was getting into when I moved up here. At times I wonder if I'll make it through the winter. At times I want to just hide in bed and let the snowstorm envelope me and not have to go to work. Then, the snow stops, I dig myself out once more, muttering, complaining, but when all is done, I feel very pleased with myself. I conquered again! And I love it here.

How often has my life been like this winter? I struggle and overcome something, just to get slammed all over again. I struggle and get out of that, and pow! something else comes along. I often feel overwhelmed. I thought I overcame that weakness, and then today I'm dealing with it all over again. At times I wonder if I knew what I was getting into when I chose to come to this planet. At times I wonder if I'll make it through this life. Then, the current storm subsides, I dig myself out once again, muttering, complaining, but when this crisis is passed, I feel very pleased with myself. I conquered again! And I love this grand adventure called life.

To many women, menopause is one of the snowstorms of life. To some the storm is light and the snow melts quickly. To others it is a major blizzard, and they feel like they will never dig out of it, that they will never be rescued from being stranded in the deep snows. Their physical symptoms: hot flashes, night sweats, racing heart, difficulty sleeping, dryness, difficulty losing weight, poor memory, etc. are bad enough. Coupled with the emotional mood swings, irritability, increased anxiety and/or depression, we may wonder why we were assigned to this miserable state of womanhood.

This is the first in a series of blogs I will be writing about menopause. Today I am talking about the emotional issues that often accompany the peri-menopause and menopausal time period. I'll get into the definitions and physical problems and treatments later.

As we go through menopause, the changing hormonal patterns actually change the physical brain and the brainwave patterns. Issues that we could deal with before now may really bother us. The way we could memorize and our thought processes and ability to focus may seem to be more difficult. But in reality, it is simply different, and it all seems hard because we are not used to this new pattern.

I compare the cycles in a woman's life to the tide of an ocean. When the tide is in (the hormones are in balance) we can handle life. We are floating. We feel on top of things. As the tide goes out (pre-menstrual period), we may get stuck in the crashing waves. Or we are tripping over the rocks and shells on the bottom of the ocean that didn't bother us before. As we start into menopause, the tide stays out longer and longer, until it is permanently out, and we may find ourselves surrounded by the rocks and shells of life that we can no longer float over. Life becomes hard. Everything bothers us. We can't hold in our anger, our frustrations. We feel guilty for not being that "I'm going to please everyone" person anymore. The snowstorms don't quit. We feel overwhelmed. We don't know how to dig out of the deep snow and move forward again.

This is when many women seek help. They go on hormone replacement therapy, they take anti-depressants, anti-anxiety medicines, sleeping pills. Sometimes these work beautifully for a while. Sometimes they don't.

But, if we choose, this snowstorm can allow for great growth, can become a blessing, can assist us into becoming wise women, wise grandmothers of the world that can affect such great change just by being who we are. I view the medicines as a great band-aid, something to help stop the bleeding while we work through the issues we are faced with. For now is the time when we are forced to look at each rock and shell, to determine which ones work for us, which ones we want to keep and make a rock garden out of, or to create a shell wreath with, or to line our path, and which rocks and shells we want to throw out. This is the time when we are forced to learn to swim as the waves are crashing over us so that we don't drown. This is the time when we can come into our own, learn who we really are for ourselves rather than being someone's wife or mother or sister or daughter or employee. This is the time when we can learn to BE WHO WE REALLY ARE.

This can all be very scary. Many of us have carried the belief that without our children, our spouse, our job, without being able to keep the house spotless, our bodies in shape, our neighbors cared for, and everyone around us in control, we are worthless. It is seemingly impossible to see ourselves as having any personal inherent worth at all. Our worth has always been in our relationships and how we serve them. But suddenly we resent all of that. The harder we try the more we seem to fail. Things don't work the way they used to. We often feel taken for granted, isolated, without emotional intimacy. We fear that if we find the Real Me inside we may not like it.

But the truth is, that part of us that is truly ME and not defined in relationship to someone else, not defined by what I do, that part of ME that I believe is connected to God, that part is inherently beautiful, loving, and wise. If we connect to that true inner self, rather than having to try to be better, we are naturally better. As we come more into alignment with our true selves instead of identifying with our ego mind that tells us we are never good enough, the more our gifts shine through and our weaknesses become less evident.

How do we shed the rocks and shells of our lives? How do we dig out of the snowstorm of changing hormones and changing brains? It is not a simple process, but it is very possible to be what we desire to be. For the next while, at the end of each blog I will put an assignment for "Finding Joy." We will do it together, because advise is easily given, but not as easily followed. I need them as much as anyone. These steps can be used by anyone facing a snowstorm of life, a difficult menopausal period being one of them.

"Finding Joy"

Assignment One: Count your successes and be excited about them

At the end of each day, I choose to take a moment to review what didn't work that day. If there was anything that I did during the day that was unlike love--any anger, fear, judgment, negative thoughts about myself or anyone else, I choose to ask for forgiveness and the strength to work on that aspect of my life again. But I choose not to dwell on these things, on my weaknesses. When this is complete, I choose to review what did work during the day. I choose to count my successes, what went well during the day. I choose to focus on these things rather than on my weaknesses and pains of life.

Sometimes simply getting out of bed is a success. I may not have gotten the dishes done but I did get the sink cleaned out, and that clean sink is beautiful! I may have gotten angry at a loved one, but I apologized, not for communicating my feelings, which is important, but for doing it in anger and defensiveness, which never can communicate love. I am pleased that I was able to admit my mistake and work through the issue. I may not have had anyone tell me they loved me, but I told myself that I loved me, in spite of my weaknesses, and I'm pleased about that I could do that, even when I didn't totally believe it. I may have had some negative thoughts about myself, but I did think that I did a pretty good job with that one assignment. I choose to focus on that.

I choose to focus on the positive, the successes, the gifts, the good things people do for me or say to me, the beauty in the world surrounding me, rather than on my and others' weaknesses, and the hard things that are happening.

This morning I was in fear that with the snow continuing the way it was I wouldn't be able to get to work tomorrow. I worried about what would happen to my patients, about if I could make enough money if I couldn't work.

My success? It happened when I bundled up and went out to the garage to get something out of the freezer. The path that I had shoveled yesterday through the arbor mess almost didn't exist. I sunk in the snow up to my knees, and then I started laughing! I realized that this is quite the adventure, and I was going to have fun. I stomped through the snow, parts of it higher that I was, shoveling a new path. I noticed the beauty, and laughed at the dogs sinking themselves while they tried to play.

I choose to believe that all is in divine order. I choose to believe that everyone and everything will be taken care of. I choose to believe that I'm OK. I choose to trust in God. That is what works for me, that is what brings me joy.

Until we meet again,

Dr. Judi

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